MEDICARE: BRAD A LARREAU DDS PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	600074615	WA

General Provider Information

NPI Number	:	1346471687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAD A LARREAU DDS PS

Provider Business Mailing Address
First Line	:	3210 SMOKEY POINT DR STE 102
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-7805
Country	:	US
Telephone Number	:	360-653-5577
Fax Number	:	360-659-1125

Provider Business Practice Location Address
First Line	:	3210 SMOKEY POINT DR STE 102
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-7805
Country	:	US
Telephone Number	:	360-653-5577
Fax Number	:	360-659-1125

Authorized Official
Title or Position	:	CONSULTANT
Name	:	MS. JULIE A DODGE
Credential	:
Telephone Number	:	206-931-4410

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	08/04/2009

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